Of course, the department store Santa had been told to direct customers to buy Macy's products, and managers are irked when they hear their Santa is sending people to Gimbels. Then the press picks up the story that Macy's is exhibiting the Christmas spirit ... and Gimbels jumps on the bandwagon, returning the favor to Macy's. Generosity spreads, business booms, and the unthinkable happens: Mr. Macy ends up shaking hands with Mr. Gimbel.
Jacque Brodt-Suggs, ISS director, application support, at Atlantic Health, a two-hospital for-profit system based in Morristown, N.J., often thinks of the movie as she bears witness to the evolution of Jersey Health Connect, a health information exchange comprising more than 25 health care facilities and two large physician practice groups.
"I've had the good fortune to participate in this from the ground up and observe how CIOs from the various health care organizations are willing to put aside the fact they're competitors and focus on the benefits to the patients," Brodt-Suggs says.
Turning goodwill into widespread reality, however, is proving a bit more complicated than that miracle on 34th.
Health information exchanges are popping up all over, but the success of the movement toward more prevalent information exchange hangs on a number of factors-acceptance of HIEs as a business model, agreed-upon data exchange standards, and perhaps most importantly, the commitment to using electronic health records, as opposed to a few discrete data elements, as the HIE foundation.
The health information exchange concept resonates with many players in the health care industry and will become more palatable as data exchange gets baked into the next stages of the EHR meaningful use incentive program.
Work in progress
That said, HIEs are still more vision than reality. According to "The State of Health Information Exchange in 2010: Connecting the Nation to Achieve Meaningful Use," a report based on the results of industry proponent eHealth Initiative's 2010 Seventh Annual Survey of Health Information Exchange, there are currently 234 known HIEs in the country.
But the majority of these initiatives are still in the early stages of HIE development-meaning they're still working on the sticky issues of shared visions, goals and implementation issues. Only 73 HIEs identified in the report are operational or "are transmitting data that is being used by stakeholders." While the HIE segment is moving forward-only 57 were exchanging data in 2009-there's still a long way to go before using HIEs as an exchange hub is common.
Exchanging the goods
Snapshots of emerging HIEs provide a sense of just how far there is to go. Providers in the Integrated Physician Network (IPN) Avista, a Louisville, Colo.-based delivery system which comprises 20 clinics, a community health center and hospital, are participating in a private HIE that's a set-up for exchanging clinical information with providers across the state in the near future.
Right now, the private HIE is not testing the limits of connectivity. All of its physicians are using a common electronic health record from NextGen Healthcare, Horsham, Pa., which is a simpler exercise than linking up to an HIE tying in multiple EHRs and vendor platforms.
"True meaningful use requires disparate providers to use HIT to improve communication, reduce errors and enhance patient care," says David Ehrenberger, M.D., chief medical officer at the network. "The ultimate goal is not just regional data integration, but interoperability that improves care at the population level with analytics. Using NextGen technology, we have 160 providers on a single EHR. So, we have the privilege of utilizing a single patient record for each patient. If an internist sees a patient and sends the patient to the orthopedist, the specialist just opens the record-and all the information is right there."
Indeed, providers in the HIE have been able to reduce the number of diabetes patients who present with elevated low-density lipoprotein (LDL) cholesterol from nearly 20 percent in October of 2008 to about 10 percent in November of 2010. According to the cholesterol guidelines of the American Diabetes Association, adults with diabetes who have high LDL cholesterol are at greater risk of heart disease.
So far, so good. But members of the private HIE are looking to exponentially multiply the usefulness of the clinical data exchange by participating in a state-wide exchange.
Participating in such an exchange will hopefully help providers- such as Ehrenberger himself-maximize the potential of their existing EHRs.
"It will take the EHRs from usable to useful," Ehrenberger says. "If I have an EHR and my patient needs a lab test, I can order the tests and the patient will go to the lab. Eventually, the lab will send a piece of paper back to me and I scan it into the electronic record. That's usable. I can do that."
Broader connectivity, however, could make the EHR technology really fulfill its potential, according to Ehrenberger. "If there's an interface to the lab, then the results can be sent to my electronic health record as discreet data elements.
The data is filed into the record automatically without any need for staff intervention. In addition, the discreet data elements can then be used for the purposes of reporting and care analysis. And, the electronic system can be used not just to improve the process of care but to improve the delivery of care itself. Now, that's useful."
To make this level of interconnectivity happen, Avista iPN is looking toward participating in the Colorado HIE, an exchange that will connect providers across the state.
The HIE is planning to connect a broad range of organizations with collaboration technology from Medicity, a Salt Lake City-based health care connectivity software company. "If a patient of mine goes to the emergency room, I will find out about that. And, I will then be able to make sure my staff gets that patient into to see me for follow-up care," Ehrenberger says.